change in receptor numbers, receptor affinity to drug, post receptor alterations, impairment of homeostatic mechanisms
What mechanisms explain different pharmacodynamics (altered drug response) in the elderly?
less (agonists and antagonists)
Elderly are ____ (more or less) sensitive to the effects of beta adrenergic stimulation
decreased baroreceptor reflex (homeostatic mechanism)
Why are elderly more susceptible to orthostatic hypertension when taking CV drugs?
TRUE/FALSE - elderly have a decreased hypotensive and decreased heart rate response to CCBs (amlodipine and verapamil)
orthostatic hypertension, decreased beta sensitivity, increased risk torsades, increased hypotension and heart rate response to CCBs (start medications SLOWLY)
What risks do seniors face concerning CV drugs and effects?
TCA, antipsychotics, loop diuretics, direct vasodilators and opioids
What other medications cause orthostatic hypotension in the elderly?
MORE (use lower doses)
Geriatric patients are _____ sensitive to the effects of drugs that gain access to the CNS
short acting (lorazepam and oxazepam)
What types of benzodiazepines should be used in the elderly?
Elderly have ___ # of cholinergic neurons
increased (breaks down Ach more)
Elderly have ____ acetylcholinesterase
Elderly have ____ # of dopamine type 2 receptors
Elderly have ____ dopamine and dopaminergic neurons in the substantia nigra
anticholinergics (diphenhydramine and many others with AC side effects)
___ can cause mental confusion, memory impairment and delirium in the elderly
glaucoma, incontinence, BPH, constipation (in addition to CNS effects and delirium)
Besides confusion what other effects do anticholinergic medications have on the elderly?
How likely an anticholinergic drug is to cause AC side effects is known as the _____
How many anticholinergic meds a patient is taking at one time is known as the ____
REPLACE, REDUCE, TIMING (replace the AC agents with highest potency, reduce dose, take at appropriate times)
If an elderly patient has a high ARS (anticholinergic Risk scale score) what should be done?
antihistamines, muscle relaxants, antiparkinson, antispasmodic, antipsychotic, hypnotic, antidepressants, antiarrhythmics
What classes of drugs have significant anticholinergic side effects?
dehydration, hyponatremia, hyperkalemia and prerenal azotemia
What fluid and electrolyte risks do elderly face on a diuretic?
Glucose tolerance ____ with age
FALSE (lower, meaning more bleeding)
TRUE/FALSE - elderly experience higher levels of vitamin K dependent clotting factors
multiple diseases, polypharmacy, atypical disease presentation
What are the factors that make lab values even more difficult to interpret in the elderly?
isoniazid, levodopa, morphine, vitamin C, nalidixic acid, penG
What drugs may lead to a positive urine glucose result?
What drug may produce a spurious increase in serum bilirubin and uric acid leading to false positive results?
FALSE (slight decrease - usually due to malnutrition or hospitalization)
TRUE/FALSE - elderly have an increase in serum albumin
FALSE (high BG because of declining glucose tolerance)
TRUE/FALSE - elderly without diabetes will have lower bloodsugar than normal
declining renal function
Uric acid rises minimally with age due to ____
Triglyceride values ____ in elderly
Vitamin b12 values ____ in elderly
Total cholesterol values _____ in elderly
PPIs, metformin (monitor for b12 in these patients)
What drugs can lead to an increase in vitamin b12?
INCREASE (investigate Paget's, it's not always osteoporosis)
Alkaline Phosphatase values _____ in elderly
TRUE (CrCl decreased by 10ml/min/decade)
TRUE/FALSE - SCr may be normal in elderly patients with a decreased CrCl
Hyponatremia in the elderly is usually due to _____
Hypernatremia in the elderly is usually due to _____
decrease (15% between 30 and 80)
Serum magnesium values ____ in the elderly
Acutely, a low Mg level is probably due to ____
INCREASES (high values indicated neoplasm, infection, or rheumatic disease)
ESR (inflammatory marker) _____ in the elderly
higher (hypothyroidism if TSH is above 10)
TSH is ____ in the elderly
prostate cancer, increases
PSA indicates ____ and the value ___ in elderly
FALSE (low HGB and HCT levels cannot be ascribed to aging alone - find the underlying cause)
TRUE/FALSE - elderly generally have low HGB and HCT levels